THE PRESIDENT OF the High Court has said that medical staff treating an elderly man with dementia who would “rather die” that have his severely infected leg amputated have been placed in an “appalling dilemma”.

The remarks were made by High Court President Justice David Barniville today after he ruled that the hospital and medical staff treating the man do not have to amputate the man’s leg against his wishes.

The judge said that the case was “problematic” due to the lack of clarity regarding the man’s capacity to make any decision about his health.

Neither than man nor the facility involved can be identified for legal reasons.

The judge was satisfied to grant a declaration that the facility and the professionals currently treating the man provide all necessary care and medical treatment to him.

The judge made his decision following an application by the HSE for a declaration that giving the man all necessary care, but not to amputate the leg, was lawful.

The HSE sought the order arising out both the man’s serious health condition and over the fact the man had clearly expressed his view that despite the risks involved, including the risk of death, he did not want his leg removed.

The judge made his decision following an application by the HSE for a declaration that giving the man all necessary care, but not to amputate the leg, was lawful.

Evidence was given to the court that arising out of his dementia the court heard that the man’s leg was in a poor condition due to his failure to properly manage his diabetes.

The application concerns a man from the West of Ireland who is aged his seventies and has been in a medical facility for some time.

The man has medical conditions including dementia and diabetes.

The man’s treating doctors say that his leg is in a very poor state and may have to be removed.

Outlining the man’s serious condition to the High Court, Donal McGuinness Bl for the HSE said the man suffers from delirium caused by his dementia.

Counsel said that the leg is infected and considered “unsalvageable” by doctors.

He said the man was also at risk of a severe bleed after a graft on his leg broke down.

Counsel said the man had “consistently and persistently” refused to consent to the amputation, even when he was told he was at risk of bleeding to death.

However, Counsel said that when presented with his condition the man has told his doctors that “if I die, I die”.

Despite the man’s objections, Counsel said the man’s family were in favour of having the amputation done and the court heard they were unwilling to take him out of hospital at the moment because of the risk involved.

The consultant surgeon in charge of the man’s care described the situation as “very difficult” adding that it was a “no win situation”.

The doctor said amputation was clearly indicated but the patient had insisted very clearly that he would rather die.

He said the medical staff were trying to respect the man and his choices, including his decision that his life had no value without his leg.

The court was told the man was not in pain and had expressed the view that he might change his mind about the proposed amputation if that situation were to change.

The court heard that if his leg was removed, he would not be able to walk again given his overall health.

He would also be unlikely to be able to return to his home.

Another consultant doctor dealing with the man’s care said all those involved in the man’s treatment have been greatly troubled by the case.

The consultant said the man would probably suffer from “post-operative delirium” if the operation went ahead.

It would not be fair to the man to try and get him mobile again and the patient would also be very angy and upset after any operation to remove the leg.

The doctor said that in one sense the removal of the leg might be what he needed, but when all other factors were into account, such a measure may be the wrong thing to do, even if amputation were to prolong his life.

The mental distress to the man would be enormous and would impact on his quality of life, the doctor added.

The man’s court-appointed guardian, or guardian ad litem, said that they met with the man, who was, they said, vehemently opposed to the amputation of his leg.

The guardian added that the man’s wishes are very clear, even though they were of the view that the man lacked mental capacity.

Ruling on the application, Justice Barniville said it was very clear the man needed the amputation to survive, but it was also his clearly and strongly expressed wish that he didn’t want his leg amputated.

The court said that a strict medical approach was “problematic”.

Allowing an amputation would solve the immediate medical crisis, but he said was likely to create a significant disturbance to the man’s mental well-being.

The man had clearly expressed the importance he places to being mobile and went for several walks a day on a walking frame in the facility where he is being treated.

The evidence to the court about the man’s ability to make decisions was not clear cut or beyond doubt.

In light of that information, the judge said he was granting the HSE’s application and made a declaration allowing doctors to take all measures short of amputating his right leg, because of the man’s clearly expressed wishes, in spite of medical advice to the contrary.

The matter will be back in court next month.